Ascus y lsil
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manejo de acuerdo a ASCCP sistema Bethesda 2014
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Ascus y lsil
- 1. ASC-US Y L-SIL DRA LUISA ROJAS JARAMILLO DIPLOMADO EN COLPOSCOPIA INSTITUTO NACIONAL DE PERINATOLOGIA
- 2. INTRODUCCIÓN • ASC-US • Atypical squamous cells (undeterminated significance) • ASC • Es la mas frecuente de todas las interpretaciones de citología cervical. • En el Sistema Bethesda 2014 sigue incluyendo como anormalidad de células escamosas epiteliales. • ASC-US y ASC-H Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 3. INTRODUCCIÓN • La mayoría de ASC-US son sugestivas de LSIL (Low-Squamous intraepithelial lesion) • Se prefiere –significado indeterminado- aprox. 10-20% HSIL • ASC • 90% ASC-US • 10% ASC-H Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 4. ASC • No representa una sola entidad biológica. • Causas no relacionadas con VPH • Inflamación • Efecto hormonal • Atrofia con degeneración • Otros. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 5. CARACTERÍSTIC AS – ASC Diferenciación escamosa Aumento en la relación núcleo/citoplasma Cambios mínimos nucleares. Hipercromasia, irregular, aglomeración cromatina, manchado, multinuclear Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 6. ASC-US • Sugestivo de LSIL • Criterios • Núcleo 2 ½ a 3 veces el área del núcleo de una cel. Escamosa Intermedia normal (35µm2) el doble del tamaño del nucleo de una cel. Metaplásica. (50µm2) • Ligeramente elevado proporción N/C • Minima hipercromasia, irregularidad en la distribución de la cromatina. • Anormalidad nuclear asociado con citoplasma denso (narangeifilico) Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 7. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 8. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 10. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 11. CRITERIOS POR PREPARACIÓN • Citología convencional • Las células pueden aparecer mas planas y alargadas por el frotis y/o artefactos por secado al aire. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 13. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 14. • Citología base liquida • Las células parecen mas pequeñas, con proporción núcleo/citoplasma mayor. Bidimensional. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 16. EXPLICACIÓ N • Las células intermedias normales están presentes en la laminilla para proveer como fuente de comparación para evaluar si cumple o no con criterios para ASC-US o LSIL • Tamaño y forma de Celulas escamosas superficiales o intermedias. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 17. La prevalencia de ASC- US declina con el incremento de la edad Mas frecuente en mujeres jóvenes y con mayor frecuencia refleja lesión relacionada por VPH Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 18. RIESGO DE NEOPLASIA EN MUJERES 30-64 AÑOS CON RESULTADO ANORMAL EN CITOLOGÍA Citología NIC2+ NIC3+ Cáncer Cervical negativa 0.68% 0.26% 0.025% ASC-US 6.9% 2.6% 0.18% HPV+ 18% 6.8% 0.41% HPV- 1.1% 0.43% - Data from: Katki HA, Schiffman M, Castle PE, et al. Benchmarking CIN 3+ risk as the basis for incorporating HPV and Pap cotesting into cervical screening and management guidelines. J Low Genit Tract Dis 2013; 17:S28. Katki HA, Schiffman M, Castle PE, et al. Five-year risks of CIN 3+ and cervical cancer among women with HPV testing of ASC-US Pap results. J Low Genit Tract
- 19. MANEJO DE ASC-US
- 21. L-SIL • Es la segunda anormalidad más comun en citología cervical https://www.uptodate.com/contents/cervical-cytology-evaluation-of-low-grade-squamous-intraepithelial-lesions- lsil?search=lsil&source=search_result&selectedTitle=1~23&usage_type=default&display_rank=1
- 22. L-SIL • Abarca displasia leve y NIC1 • Varios estudios han demostrado que los criterios morfológicos para distinguir la “koilocitosis” de la displasia leve o CIN I varían entre los investigadores y carecen de importancia clínica Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 23. CRITERIOS PARA LSIL • Células pueden ser individual, en grupos, en hojas • Cambios citológicos se confinan en células escamosas intermedias o superficial madura. • Tamaño grande con citoplasma bien definido “maduro” bastante abundante. • Núcleo 3veces mayor al de un núcleo de una cel intermedia normal. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 24. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 25. CRITERIOS PARA LSIL • Generalmente nucleo hipercromatico. • Anisonucleosis • Cromatina con distribución uniforme(granulos grueso, manchado denso, opaco) • Contorno nucleas variable (irregular o suave) • Bi o multinuclear • Nucleolos ausentes o no visibles. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 26. • Koilocitos o cavitación perinuclear. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 27. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 28. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
- 29. CRITERIO POR PREPARACIÓ N DE LA MUESTRA En ambas son minimas diferencias LBC menos hipercromasia
- 30. RIESGO DE NEOPLASIA Citología NIC2+ NIC3+ Cáncer Cervical LSIL 16% 5.2% 0.16% HPV+ 19% 6.1% HPV- 5.1% 2.0% - Katki HA, Schiffman M, Castle PE, et al. Five-year risks of CIN 2+ and CIN 3+ among women with HPV-positive and HPV-negative LSIL Pap results. J Low Genit Tract Dis 2013; 17:S43.
Editor's Notes
- A 32-year-old woman. Atypical intermediate squamous cells with a nucleus 2−3Å~ the area of a normal intermediate squamous cell nucleus and mild irregularity of nuclear contour. This isolated cell has some features suggestive of HPV infection. hrHPV was positive. Follow-up biopsy revealed LSIL (CIN1)
- ASC-US ( LBP, ThinPrep ). A 28-year-old woman. An intermediate squamous cell with an enlarged nucleus and slight nuclear membrane irregularity. The atypical features do not meet the criteria for LSIL. hrHPV was positive. Follow-up biopsy revealed LSIL (CIN1)
- ASC-US ( LBP, SurePath ). Routine screen from a 32-year-old woman. Single atypical squamous cell with ill-defi ned cytoplasmic halo in a background of infl ammation. Adjacent squamous cell shows adherent lactobacilli. HPV testing was not performed on this sample
- ASC-US ( LBP, ThinPrep ). A 28-year-old female. An atypical binucleated intermediate cell with molded nuclei and orangeophilic cytoplasm suggestive but not diagnostic of LSIL. hrHPV was positive. Follow-up biopsy revealed LSIL (CIN1)
- Negative for intraepithelial lesion or malignancy (NILM) versus atypical squamous cells – undetermined signifi cance (ASC-US) ( CP ). Perimenopausal woman. Mature squamous cells show mild nuclear enlargement, binucleation, and even chromatin distribution. Note benign endocervical cells at bottom of fi eld
- ASC-US ( CP ). Cells with multinucleation, nuclear enlargement, and air-drying artifact, possibly representing LSIL (CIN1)
- ASC-US ( LBP, SurePath ). A 21-year-old woman. Thick cohesive sheet of cells with focal nuclear enlargement, orangeophilic cytoplasm, poorly formed cytoplasmic vacuoles, and binucleation. Follow-up biopsy was LSIL (CIN1)
- Nuclear area ( LBP , ThinPrep ). The nuclear area of an intermediate squamous cell is approximately 35 μm 2 . This is used as a reference to measure abnormal squamous cells such as ASC-US (approximately 100 μm 2 ) and LSIL (approximately 150–175 μm 2 )
- LSIL ( LBP , ThinPrep ). A 32-year-old woman, day 15, routine cervical cytology screening. Note the overall large cell size, “smudged” nuclear chromatin, well-defined cytoplasm, and multinucleation
- LSIL ( LBP , ThinPrep ). Routine screen from a 32-year-old woman. Nuclear abnormalities are required to make an interpretation of LSIL. HPV cytopathic effect manifested by perinuclear cavitation often accompanies the nuclear abnormalities but is not required for an interpretation of LSIL Fig.
- LSIL ( LBP , SurePath ). Cells with diagnostic koilocytic features of LSIL have a sharply defi ned perinuclear cavity, condensation of cytoplasm around the periphery, and abnormal nuclear features including enlargement and nuclear membrane irregularity. In liquid-based samples, nuclear hyperchromasia may be less evident